Caitlin McGrath and Paul Schubert Lock Haven University of Pennsylvania 2012

Background  Growing Problem  140% increase in Obesity (7)  Concomitant growth 9.3%

Background Continued  Diet and Exercise Important and works Rarely durable (1)  Current Standards of Treatment Sensitizers (Metformin, Pio/Rosiglitizone) Insulin secretagogues (Glipizide) Insulin Injections (Humolog, Lantus)  Expensive Requires increased amounts of medication as time goes on (1)

Background Continued  BARIATRIC SURGERY

Methods  Literature Review Effectiveness of methods Power of their results

Results  Range of Results Lap-Gastric Band – 48% Biliopancreatic Diversion with Duodenal Switch – 98% 70-95% with other methods

Discussion - Effectiveness  Viable Option Effectively resolves diabetes Cosmetic Cost effective  Payment Out of pocket HTN medications  Surgical Complications

Discussion - Physiology  Days to weeks  Theories Starvation Grehlin GLP-1 Unknown

Disscussion – Starvation  Most obvious  Decreased caloric intake

Disscussion – Ghrelin  Makes you hungry  Low levels post bariatric surgery Possible reason for diabetes resolution

Disscussion – GLP-1  Multiple effects Increases insulin release in response to hyperglycemia Decreases pancreatic beta cell apoptosis  Increased after bariatric surgery

Disscussion – Which surgery?  Gastric Banding vs More invasive  Complications

Discussion – Oral Medications  Miracle Cure?  Oral Medications  Fewer diabetes complications

Conclusion  Must have a change  Don’t have oral medications yet  Bariatric Surgery is the best we have

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